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TOPIC: Dr. Tsay Questions & Answers!

Dr. Tsay Questions & Answers! 1 year 9 months ago #1308708494

The following are Q&A submissions from Dr. Tsay.

(1.) How much Girth/circumference can you achieve with Girth enhancement?
Generally speaking, for our fat transfer patients, we can put upwards of 50cc’s of fat at a time, and patients can expect a 15-25% increase in Girth in a single session. For example, if you start with a Flaccid circumference of 4 inches, you could reasonably expect to go to 5 inches in circumferential measurement (which can be visually significant).

For dermal fillers, we don’t want to put too much in at one time. I generally like to cap that out between 10-15cc’s per visit. You’re going to get a mild increase in Girth in one session. When you build upon that over multiple sessions, I find that 50cc’s (in total) is the sweet spot for the average size penis to really see a significant Girth enhancement.

(2.) How long can filler injections take and what kind of anesthesia is used?
This procedure is all done under local anesthesia. I find that this is generally sufficient enough, and we also offer nitrous oxide (i.e. laughing gas) if you are at all nervous prior to coming in. We can also prescribe sedatives that will give you a calming experience throughout the procedure.

(3.) Can Girth injections affect the function or sensitivity of the penis? What complications are there to consider?
Some of the common complications are bruising and swelling. This is usually self-limited and lasts 7-10 days. We usually recommend not to use the organ (penis) for at least one week after the procedure. Not only will the penis be sore, but there will be open wounds that need to be completely healed before resuming any sexual activity.

(4.) How does the newly Girth enhanced penis feel?
We usually follow up with the procedure about 2-3 weeks afterwards, and at that time the swelling is gone, the bruising is gone, and you can really appreciate the final result from either the fat transfer or Dermal Filler placement.

(5.) Can you gain length from Girth injections?
So the procedures (fat or Dermal Filler) don’t give you an increase in length per se, but more than half my clients who state they appreciate the increase in Girth, also say that their Flaccid length increases as well. So that is a beneficial “side effect” of Girth enhancement.

(6.) What to expect with a procedure?
At Ageless MD, we offer a variety of different fillers, as well as fat transfer, to enhance the overall Girth of your Flaccid and Erect penis. We also use dermal fillers to enhance and increase the size of the glans.

(7.) Can you tell us more about the use of Platelet Rich Plasma (PRP) to aid gains?
Many of our patients combine their penile enhancement with PRP. When that happens, the PRP has regenerative properties, so it increases the quality of the Erection, the duration of the Erection, and the sensation around the glans.

(8.) What is your preference of filler and/or brand?
At Ageless MD, we use a variety of different filler products to enhance the Girth of your penis. The most obvious would be fat tissue; this involves a fat transfer via miniature liposuction from your lower belly. We process the fat to be micronized, and used in a syringe to be injected all along your shaft to increase your Girth. I believe fat is the best filler, assuming you have enough to harvest for Girth enhancement.

If you don’t have enough fat, there are a lot of other choices such as fillers made of Hyaluronic Acid (HA). There is also another filler called Radiesse that we use and that’s made of Calcium Hydroxyapatite (CaHa). The reason I like this filler in particular, is that CaHa is found in your bones. What better product that is already naturally occurring in your body, that we can use to put into the penis to mimic a firm, hard Erection.

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Last edit: by Skeptical_One.

Dr. Tsay Questions & Answers! 1 year 8 months ago #1308708775

(9.) Do you have a preference for Renuva or Hyaluronic Acid (HA) for penile Girth enhancement? If not, could you describe the pros & cons of each?
This question is not that simple to answer. If it were for myself personally, I would want to use Renuva. The main reason would be longevity. HA's are safe and have been around for decades. The results are very consistent and predictable (in the right hands). Renuva is still a fairly new product to the market and not that many people are familiar with what it is and what it can do. Ive been using it already for more than 5 years for aesthetic purposes in the face and body. Initially, I would use Renuva in Male Enhancement to "top off" a fat transfer procedure that I had already performed because Renuva causes your body to grow its own fat. Gradually I am using Renuva more and more for Girth augmentation even as an alternative to fat transfer. It is extremely easy to use right out of the box. There is no liposuction needed to harvest ones fat which reduces the downtime and recovery from a mini liposuction procedure. During Covid supply chain issues caused a pause in the sale of Renuva, but in 2022 the inventory has been robust and without any limitations on accessing product. So Renuva game on!

(10.) Do you use a blunt-tip cannula or needle for injections?
95% of time I am doing this procedure I am using a blunt tip cannula. Either a 22 G 50 mm or 22 G 70 mm depending on how long the organ is. When I reassess and have to finalize and even things out, I connect a 27 gauge 1/2 Inch needle that comes with the HA product and inject the remaining with a needle for fine tuning. For glans augmentation I use a small needle and only inject a maximum of 5 ml in 1 session for safety reasons.

(11.) What, if any, are the risks of filler migration?
The penis not a static organ like a chin or or ear. It lengthens, retracts, curves and reaches different directions when being used. With that being said, filler migration is to be expected. For the first month following a Girth enhancement procedure, the product can be manipulated/massaged to even out any irregular distribution. After 2 months the product has almost fully integrated into the tissue so there is less change of moving things around. As long as the product is placed in the proper plane, this should not cause any issues such as migration of filler somewhere else and staying there long term.

(12.) How many sessions can a patient expect to achieve an ideal result?
This all depends on the budget of the patient and how quickly they want to achieve their goals. If they want full correction as quickly as possible, this can happen with a 1-2 fat transfer sessions. With HA fillers or Renuva, this can take several sessions and the goal can be obtained incrementally, which is not a bad thing.

(13.) What makes an ideal candidate?
An ideal candidate is someone who is Circumcised, does not have any preexisting scar tissue, someone who desires mainly Girth enhancement, and has reasonable expectations of reaching their goal. In many instances ones goals may change over time. For example, a patient may initially want to go from 3.5 inches in Flaccid Girth to 4.2 inches. This is 20% and visibly very noticeable. Its not KING KONG size by most standards, but they may enjoy that for a while and later want to go further and try to attain 4.8-5 inches in Girth and be the king of the locker room. As long as one is doing this in a safe manner using safe products, this is the most important factor to consider.

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Last edit: by PhalloBoardsSystemAccount.

Dr. Tsay Questions & Answers! 1 year 4 months ago #1308710434

(14.) How long can you wait before resuming intimacy or strenuous activity after a procedure?
We generally recommend 2 weeks of refraining from any sexual inter course including masturbation or oral sex. The genital area has a very high concentration of bacteria normally.
The Girth Enhancement procedure involves making puncture marks into the skin which means bacteria can enter the port holes in the skin and cause an infection.
The “port holes” technically close after 1 week but we recommend 2 weeks refraining from sex to add an extra measure of safety.

(15.) Best Circumcision for Girth Enhancement (Filler)?
Not all circumcisions are the same. There is one type of Circumcision that is best suited for Girth Enhancement procedure. This type is called low and tight. This is where the scar is near the neck of the penis (right below the corona) and the skin surrounding the incision is right and NOT loose. If the skin is still too loose the filler can migrate.

(16.) Can Filler cause ED?
Theoretically yes if the filler was injected in the incorrect plane or layer of the skin. But generally speaking there is NO direct evidence linking Girth Enhancement procedures to ED.
ED can be caused by numerous factors which include psychological problems. If a patient has subsequent psychological issues after receiving a Girth Enhancement procedure they may encounter ED as a secondary cause of their procedure.

(17.) Can Girth enhancement injections be performed on a penis that uses an inflatable implant?
This really depends on the patient and the decision to work or not work on this type of patient would be on a case by case basis. For example if there was an implant inserted that caused subsequent infections or complications such as scar tissue, this could cause problems with the Girth Enhancement procedure.

(18.) Are there any solutions for glans enlargement?
You can inject fillers into the glans to increase the size. However this part of the organ is extremely vascular so the practitioner has to be very careful when injecting so as to not accidentally inject the product into the vascular of the glans. I like to keep the number of mL injected here to a minimum (I only inject a maximum of 5 mL of HA) and ask the patient to come back to add more product at a later date.

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Last edit: by PhalloBoardsSystemAccount.

Dr. Tsay Questions & Answers! 2 months 2 weeks ago #1308716255

(19.) Do Girth Dermal Filler injections adversely impact blood pressure or increase risks of hypertension?
Dermal fillers absolutely do not affect blood pressure or increase risk of hypertension. They are strictly placed underneath the skin of the shaft and have no systemic effects whatsoever. The only rare issues are granulomas which can happen with any product and cannot be predicted or prevented. Sometimes the body's immune system can get activated which then attacks the dermal filer causing a granuloma or inflammatory Nodule. Almost all of these issues are easily treated with local steroid injections.

(20.) Why are high volume silicone-oil injections into the penis regarded as the least safe or least ethical option as a Girth filler by the PhalloBoards Moderation Team and many of its Sponsors? Have you ever dealt with patients who have had botched silicone injections from another Clinics come to you for Revision?
FDA had issued warning in 2017 and again in 2021 against use of injectable silicone for facial or body contouring. In fact silicone has never been approved by the FDA for any dermatological condition. This "ingredient" or "product" is not very predictable in the skin and have known to spread and cause systemic side effects years later such as pneumonitis, ulcerations, migration, hyperpigmentation of the skin overlying the silicone. I have never seen a GE procedure from another clinic with a complication but I have seen it in the buttocks and lip, where the treatment of the complication required invasive procedures that left the patients with many unsightly scars.

(21.) Despite complications from correctly performed dermal injections being rare, foreign born granulomas (FBGs) are often regarded as the worst-case scenario complication. Have you experienced FBGs in your Practice? How would you go about treating this issue in the event a patient experiences signs of an FBG?
Granulomas can happen with any substance injected or implanted into the skin. By definition anything except for autologous grafting can cause a granuloma. An example would be if you suffered a viral infection such as the flu and the body mounted an immune response that decided to attack the substance that was injected. We advise avoiding any dental procedures or vaccinations 2 weeks before or after Dermal Filler injections to prevent this. Depending on how severe is the granuloma, I would typically inject a steroid such as triamcinolone into the granuloma and majority of the time this would resolve the issue. Not super common but I have seen a couple and indeed were mild. Sometimes if the granuloma was not even visible and we decided to leave it alone.

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